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European Spine Journal

Erschienen in:

01.03.2013 | Original Article

Posterior instrumentation, anterior column reconstruction with single posterior approach for treatment of pyogenic osteomyelitis of thoracic and lumbar spine

verfasst von: M. Gorensek, R. Kosak, L. Travnik, R. Vengust

Erschienen in: European Spine Journal | Ausgabe 3/2013

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Abstract

Purpose

Surgical treatment of thoracolumbar osteomyelitis consists of radical debridement, reconstruction of anterior column either with or without posterior stabilization. The objective of present study is to evaluate a case series of patients with osteomyelitis of thoracic and lumbar spine treated by single, posterior approach with posterior instrumentation and anterior column reconstruction.

Methods

Seventeen patients underwent clinical and radiological evaluation pre and postoperatively with latest follow-up at 19 months (8–56 months) after surgery. Parameters assessed were site of infection, causative organism, angle of deformity, blood loss, duration of surgery, ICU stay, deformity correction, time to solid bony fusion, ambulatory status, neurologic status (ASIA impairment scale), and functional outcome (Kirkaldy-Willis criteria).

Results

Mean operating time was 207 min and average blood loss 1,150 ml. Patients spent 2 (1–4) days in ICU and were able to walk unaided 1.6 (1–2) days after surgery. Infection receded in all 17 patients postoperatively. Solid bony fusion occurred in 15 out of 17 patients (88 %) on average 6.3 months after surgery. Functional outcome was assessed as excellent or good in 82 % of cases. Average deformity correction was 8 (1–18) degrees, with loss of correction of 4 (0–19) degrees at final follow-up.

Conclusions

Single, posterior approach addressing both columns poses safe alternative in treatment of pyogenic vertebral osteomyelitis of thoracic and lumbar spine. It proved to be less invasive resulting in faster postoperative recovery.

Acosta FL Jr, Chin CT, Quinones-Hinojosa A, Ames CP, Weinstein PR, Chou D (2004) Diagnosis and management of adult pyogenic osteomyelitis of the cervical spine. Neurosurg Focus 17:2CrossRef

Butler JS, Shelly MJ, Timlin M, Powderly WG, O’Byrne JM (2006) Nontuberculous pyogenic spinal infection in adults: a 12-year experience from a tertiary referral center. Spine 31:2695–2700PubMedCrossRef

Cramer J, Haase N, Behre I, Ostermann PAW (2003) Spondylitis und spondylodiszitis. Trauma Berufskrankheit 5:336–341CrossRef

Frangen TM, Kälicke T, Gottwald M, Andereya S, Andress HJ, Russe OJ, Muller EJ, Muhr G, Schinkel C (2006) Die operative Therapie der Spondylodiszitis. Eine Analyse von 78 Patienten. Der Unfallchirurg 109:743–753PubMedCrossRef

Schinkel C, Gottwald M, Andress HJ (2003) Surgical treatment of spondylodiscitis. Surg Infect 4:387–391CrossRef

Butler JS, Shelly MJ, Timlin M, Powderly WG, O’Byrne JM (2006) Non tuberculous pyogenic spinal infection in adults: a 12-year experience from a tertiary referral centre. Spine 31:2695–2700PubMedCrossRef

Nolla JM, Ariza J, Gomez-Vaquero C, Fiter J, Bermejo J, Valverde J, Escofet DR, Gudiol F (2002) Spontaneous pyogenic vertebral osteomyelitis in non-drug-users. Semin Arthritis Rheum 31:271–278PubMedCrossRef

Linhardt O, Matussek J, Refior HJ, Krödel A (2007) Long-term results of ventro-dorsal versus ventral instrumentation fusion in the treatment of spondylitis. Int Orthop 31:113–119PubMedCrossRef

Woertgen C, Rothoerl RD, Englert C, Neumann C (2006) Pyogenic spinal infections and outcome according to the 36-Item Short Form Health Survey. J Neurosurg Spine 4:441–446PubMedCrossRef

10.

Dimar JR, Carreon LY, Glassman SD, Campbell MJ, Hartman MJ, Johnson JR (2004) Treatment of pyogenic vertebral osteomyelitis with anterior debridement and fusion followed by delayed posterior spinal fusion. Spine 29:326–332PubMedCrossRef

11.

Fayazi AH, Ludwig SC, Dabbah M, Bryan Butler R, Gelb DE (2004) Preliminary results of staged anterior debridement and reconstruction using titanium mesh cages in the treatment of thoracolumbar vertebral osteomyelitis. Spine J 4:388–395PubMedCrossRef

12.

Gasbarrini AL, Bertoldi E, Mazzetti M, Fini L, Terzi S, Gonella F, Mirabile L, Barbanti Brodano G, Furno A, Gasbarrini A, Boriani S (2005) Clinical features, diagnostic and therapeutic approaches to haematogenous vertebral osteomyelitis. Eur Rev Med Pharmacol Sci 9:53–66PubMed

13.

Korovessis P, Petsinis G, Koureas G, Iliopoulos P, Zacharatos S (2006) One-stage combined surgery with mesh cages for treatment of septic spondylitis. Clin Orthop Relat Res 444:51–59PubMedCrossRef

14.

Priest DH, Peacock JE Jr (2005) Hematogenous vertebral osteomyelitis due to Staphylococcus aureus in the adult: clinical features and therapeutic outcomes. South Med J 98:854–862PubMedCrossRef

15.

Schuster JM, Avellino AM, Mann FA, Girouard AA, Grady MS, Newell DW, Winn HR, Chapman JR, Mirza SK (2000) Use of structural allografts in spinal osteomyelitis: a review of 47 cases. J Neurosurg 93:8–14PubMed

16.

Hodgson AR, Stock FE (1956) Anterior spinal fusion a preliminary communication on the radical treatment of Pott’s disease and Pott’s paraplegia. Br J Surg 44:266–275PubMedCrossRef

17.

Heyde CE, Boehm H, El Saghir H, Tschoke SK, Kayser R (2006) Surgical treatment of spondylodiscitis in the cervical spine: a minimum 2-year follow-up. Eur Spine J 15:1380–1387PubMedCrossRef

18.

Chen WH, Jiang LS, Dai LY (2007) Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation. Eur Spine J 16:1307–1316PubMedCrossRef

19.

Waring WP 3rd, Biering-Sorensen F, Burns S, Donovan W, Graves D, Jha A, Jones L, Kirshblum S, Marino R, Mulcahey MJ, Reeves R, Scelza WM, Schmidt-Read M, Stein A (2010) 2009 review and revisions of the international standards for the neurological classification of spinal cord injury. J Spinal Cord Med 33:346–352PubMed

20.

Krödel A, Krüger A, Lohscheidt K, Pfahler M, Reflor HJ (1999) Anterior debridement, fusion, and extrafocal stabilization in the treatment of osteomyelitis of the spine. J Spinal Disord 12:17–26PubMed

21.

Safran O, Rand N, Kaplan L, Sagiv S, Floman Y (1998) Sequential or simultaneous, same day anterior decompression and posterior stabilization in the management of the vertebral osteomyelitis of the lumbar spine. Spine 23:1885–1890PubMedCrossRef

22.

Jain AK, Dhammi IK, Prashat B, Sinha S, Mishra P (2008) Simultaneous anterior decompression and posterior instrumentation of the tuberculous spine using an anterolateral extrapleural approach. J Bone Jt Surg B 90:1477–1481CrossRef

23.

Stener B (1989) Complete removal of vertebrae for extirpation of tumors. Clin Orthop 245:72–82PubMed

24.

Tomita K, Kawahara N, Baba H, Tsuchiya H, Fujita T, Toribatake Y (1997) Total en bloc spondylectomy. A new surgical technique for primary malignant vertebral tumors. Spine 22:324–333PubMedCrossRef

25.

Halpern EM, Bacon SA, Kitagawa T, Lewis SJ (2010) Posterior transdiscal three-column shortening in the surgical treatment of vertebral discitis/osteomyelitis with collapse. Spine 35:1316–1322PubMedCrossRef

26.

Rath SA, Neff U, Schneider O, Richter HP (1996) Neurosurgical management of thoracic and lumbar vertebral osteomyelitis and discitis in adults: a review of 43 consecutive surgically treated patients. Neurosurgery 38:926–933PubMedCrossRef

27.

Hempelmann RG, Mater E, Schön R (2010) Septic hematogenous lumbar spondylodiscitis in elderly patients with multiple risk factors: efficacy of posterior stabilization and interbody fusion with iliac crest bone graft. Eur Spine J 19:1720–1727PubMedCrossRef

28.

Lee JS, Suh KT (2006) Posterior lumbar interbody fusion with an autogenous iliac crest bone graft in the treatment of pyogenic spondylodiscitis. J Bone Jt Surg B 88:765–770CrossRef

29.

Zaveri GR, Mehta SS (2009) Surgical treatment of lumbar tuberculous spondylodiscitis by transforaminal lumbar interbody fusion (TLIF) and posterior instrumentation. J Spinal Disord Tech 22:257–262PubMedCrossRef

30.

Fukuta S, Miyamoto K, Masuda T, Hosoe H, Kodama H, Nishimoto H, Sakaeda H, Shimizu K (2003) Two-stage (posterior and anterior) surgical treatment using posterior spinal instrumentation for pyogenic and tuberculotic spondylitis. Spine 28:302–308

31.

Dai L, Chen W, Jiang L (2008) Anterior instrumentation for the treatment of pyogenic vertebral osteomyelitis of thoracic and lumbar spine. Eur Spine J 17:1027–1034PubMedCrossRef

32.

Ruf M, Stoltze D, Merk HR, Ames M, Harms J (2007) Treatment of vertebral osteomyelitis by radical debridement and stabilization using titanium mesh cages. Spine 32:275–280CrossRef

33.

Hee HT, Majd ME, Holt RT, Pienkowski D (2002) Better treatment of vertebral osteomyelitis using posterior stabilization and titanium mesh cages. J Spinal Disord Tech 15:149–156PubMedCrossRef

34.

Liljenqvist U, Lerner T, Bullmann V, Hackenberg L, Halm H, Winkelmann W (2003) Titanium cages in the surgical treatment of severe vertebral osteomyelitis. Eur Spine J 12:606–612PubMedCrossRef

35.

Yong HP, Jong DP, Young-Geun C, Sang-Ho L (2009) Anterior debridement and fusion followed by posterior pedicle screw fixation in pyogenic spondylodiscitis: autologous iliac bone strut versus cage. J Neurosurg Spine 8:405–412

36.

Walter J, Kuhn SA, Reichart R, Kalff R, Ewald C (2010) PEEK cages as a potential alternative in the treatment of cervical spondylodiscitis: a preliminary report on a patient series. Eur Spine J 19:1004–1009PubMedCrossRef

37.

Mondorf Y, Gaab MR, Oertel JM (2009) PEEK cage cervical ventral fusion in spondylodiscitis. Acta Neurochir 151:1537–1541PubMedCrossRef

38.

Cavuşoğlu H, Kaya RA, Türkmenoğlu ON, Tuncer C, Colak I, Aydin Y (2008) A long-term follow-up study of anterior tibial allografting and instrumentation in the management of thoracolumbar tuberculous spondylitis. J Neurosurg Spine 8:30–38PubMedCrossRef

39.

Blondel B, Fuentes S, Pech-Gourg G, Metellus P, Dufour H (2011) Minimally invasive osteosynthesis in septic conditions. Neurochirurgie 57:15–20PubMedCrossRef

Titel: Posterior instrumentation, anterior column reconstruction with single posterior approach for treatment of pyogenic osteomyelitis of thoracic and lumbar spine
verfasst von: M. Gorensek
R. Kosak
L. Travnik
R. Vengust
Publikationsdatum: 01.03.2013
Verlag: Springer-Verlag
Erschienen in: European Spine Journal / Ausgabe 3/2013
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-012-2487-5

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